Eating Disorders Treatment: Evidence-based or Opinion-based?

Good Question...Complicated Answer

As a big fan of evidence-based treatment of illness, the first question I get is "what does that MEAN?"

There are definitions out there, like this one, that sound great but are hard to see how to use. Or we could just check Wikipedia.

I find that defining "evidence-based" is more about what it is NOT. It is not opinion.

We assume this with drug treatments, for example. We assume any drug our pharmacist packages up for us has been tested for efficacy and for safety. We assume it has been compared with other drugs. We would be shocked if the medicine prescribed on a hunch, because the doctor had tried it before on people and they'd felt better, or because it seemed like it should work. Any doctor who prescribed, or pharmacist who bottled, an untested treatment would be subject to legal action.

Psychological treatments, and treatment of psychological symptoms, don't operate under the same standard. Most have not been compared to others in equal trials. Most are not evaluated for safety. There are no enforceable rules for when to prescribe what, and no banned treatments. Opinion-based treatment can have its genesis in anything from university training to ideas formed in dreams.

Dehumanizing and mechanistic

Many people object to the idea of having psychological symptoms treated by rules or guidelines. Some believe the idea of "evidence-based" practice is dehumanizing and mechanistic. I understand this and actually sympathize: the idea of evidence-based practice can go too far. In a field where so little has been researched, we cannot stake certainty on the bits we know.

A wonderful recent piece in the Eating Disorders Review, available online, gives an overview of the gap between research and practice in the eating disorder world - with a bit of context about the larger mental illness treatment world.

Why am I so big on evidence-based practice? The obvious answer would be because they are more likely to be effective. But the larger truth is that there are so many sincere but unhelpful, and even actively harmful treatments out there and no way for families to know the difference. Knowing who to trust can't be a matter of what sounds best or easiest or fits into our lifestyle. It needs to be based on evidence, and not opinion - this is too important an issue.